Name
Phone1
Phone2
Email
How do you prefer to receive confirmation of scheduled cleaning appointments?
by phone by email
Preferred days and times for cleaning
House Address
City
State
Zip
# of pets
How many sets of stairs (total)
Pets are allowed
Inside Only Outside Only Both
Pets are
Friendly Not Friendly
Describe your pets (names and any other helpful information):
Cleaning products
Do you prefer non-toxics only, or are some bleach-based products ok when needed?
Bedrooms
XL - fits king size bed and furniture
Large - fits queen size bed and furniture
Medium - fits double or full size bed and furniture
Small - fits twin bed or crib and furniture
Bedroom #1
XL L M S
Bedroom #2
XL L M S
Bedroom #3
XL L M S
Bedroom #4
XL L M S
Bedroom #5
XL L M S
Size of bathroom
XL – has separate shower and tub plus toilet and sink(s)
L – has a combination shower and tub plus toilet and sink
Medium – has a shower OR a tub plus toilet and sink
Small – has only a toilet and sink
Bathroom #1
XL L M S
Shower and/or sink area has tile
yes no
Bathroom #2
XL L M S
Shower and/or sink area has tile
yes no
Bathroom #3
XL L M S
Shower and/or sink area has tile
yes no
Bathroom #4
XL L M S
Shower and/or sink area has tile
yes no
Kitchen
XL – larger kitchen with plenty of room for an island, prep sink, etc.
Large – average sized kitchen for a house, may have room for an island
Medium – larger apartment sized kitchen
Small – smaller apartment sized kitchen
XL L M S
Living Room
XL – larger, ‘entertaining’ sized living room, room for a couch, side chairs, coffee table, TV and lots of other furniture
Large – Average sized living area for house, room for couch, chiar coffee table and TV
Medium – larger apartment sized living area or living room for a smaller house, room for a couch, chair and not a lot of other furniture.
Small – apartment living room with couch and not a lot of other furniture.
XL L M S
Dining Room
XL – larger, ‘entertaining’ sized dining room, room for a table plus lots of other furniture
Large – Average sized dining area for house, room for table, plus one or two pieces of other furniture
Medium – smaller dining area for a house, only room for a dining table
Small – eating nook or apartment dining area
XL L M S
Additional Services
To customize your service, let us know which of the following services, if any, you would like to add to your cleaning
Clean small countertop apppliances
Clean the dish drain
Detail clean kitchen items such as burner knobs, dishwasher screws
Remove mildew stains from grout
(requires toxic solutions; may require grout specialist)
Spot clean telephones
Clean fingerprints on doorway trim, doors and light switch covers
Clean windows and sliding doors
Dust blinds (may require a blinds cleaning specialist)
Change towels and/or bed linens
Remove trash and recycling; clean bins
Sweep the porch and front steps
Optional Sub-contracted Services
Please send me estimates for these options:
Carpet cleaning
Handyman services
Window washing
Gutter cleaning
Pressure washing
Professional organizing for home or office
Grout restoration or repair
Window blinds cleaning
Wall washing
Gardening and landscaping
Interior and exterior painting
Electrical Work
Staging (professional redecorating)